<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320184
Report Date: 07/23/2025
Date Signed: 07/23/2025 09:58:46 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2025 and conducted by Evaluator Jose Anguiano
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250714124630
FACILITY NAME:AVENIR MEMORY CARE WESTSIDEFACILITY NUMBER:
198320184
ADMINISTRATOR:JODI KANOWITZFACILITY TYPE:
740
ADDRESS:7501 OSAGE AVETELEPHONE:
(424) 282-0040
CITY:LOS ANGELESSTATE: CAZIP CODE:
90045
CAPACITY:88CENSUS: 55DATE:
07/23/2025
UNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Ashley ShireTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee did not follow mandated reporter requirements
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/23/2025 around 9:00 AM Licensing Program Analyst (LPA) Jose Anguiano conducted a subsequent unannounced complaint visit. LPA met with the Director of Sales Ashley Shire and the purpose of the visit was explained. LPA was granted entry to the facility.
The investigation consisted of the following: On 07/17/2025, around 10:00AM LPA Anguiano interviewed four staff members (S1–S4), interviewed 7 out of 56 residents (R1-R7) and conducted facility, staff, and resident records. LPA also reviewed Title 22 Regulations regarding Reporting Requirements.
The investigation revealed the following: Regarding the allegation “Licensee did not follow mandated reporter requirements”, it is being alleged that the administrator did not submit a mandated report within two hours of a physical abuse incident that happened on 07/11/2025.

Please see LIC9099-C for report continuation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 11-AS-20250714124630
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: AVENIR MEMORY CARE WESTSIDE
FACILITY NUMBER: 198320184
VISIT DATE: 07/23/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Interviews conducted revealed the following: 4 out of the 4 staff members (S1-S4) did not agree with the allegation, S1 indicated that S1 immediately diffused the situation and reported the incident to S2. S2 asked the non-resident to leave the facility and explain that it needs to be reported. 7 out of the 7 residents (R1-R7) did not agree with the allegation. R1 indicated talking to the staff about the incident and having support. LPA observations revealed the following: LPA did not observe any visible injuries from R1. Records review revealed the following: Facility incident report dated 07/17/2025 indicated that the incident that happened on 07/11/2025 did not result in serious bodily injury. LPA’s review of Title 22 Regulations 87411(b) Reporting Requirements indicates that “Any suspected physical abuse that results in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within two (2) hours as required by Welfare and Institutions Code Section 15630(b)(1).” During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation. Based on the evidence gathered, interviews conducted, and records reviewed, although the allegation “Licensee did not follow mandated reporter requirements” may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.
An exit interview was conducted, and a copy of this Complaint Report was given to Ashley Shire.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2